Authored by: Shawn Baker, Chief Nutritionist, USAID Link to bio
One of the challenging things about addressing stunting is the complex web of factors that contribute to the condition. There is no silver-bullet solution, because there is no single cause of chronic undernutrition.
To help us think systematically about how to tackle this complexity, we’ve talked in recent years in terms of nutrition-specific and nutrition-sensitive interventions. Nutrition-specific interventions relate to the immediate determinants of growth and development, such as breastfeeding, complementary feeding and micronutrient intake, for example. Nutrition-sensitive interventions, on the other hand, relate to underlying determinants, such as basic food security, health interventions and education. Now we’re updating the framework slightly, and we’re thinking in terms of direct and indirect interventions (which more or less map to nutrition-specific and nutrition-sensitive) in the health and non-health sectors. Even using this mental model, it can be difficult to determine how much effect a given intervention is having, because data limitations mean we have to use proxy indicators, especially when it comes to direct interventions which are usually delivered through from the health sector and solid quantification of quality of diets.
That said, the analysis from Exemplars in Global Health (EGH) may be pointing to a bit of a shift in our thinking: In the past, we believed that about two thirds of the key interventions happened inside the health sector, and about one third happened outside of it. There are indications in the countries where the EGH research was carried out that the split may be closer to 50/50. On average, about half the successful interventions in our Exemplar countries came from a non-health sector. (It is important to note, though, that the 50/50 split I mentioned is an average across the countries we’ve studied. Each country’s experience is unique.)
The EGH analyses suggest two things. First, direct interventions are “non-negotiable.” In every case, they account for a significant portion of the impact the EGH program studied. Second, non-health sectors may play a more important role than we knew, and we should keep pushing ourselves to collaborate across traditional sectoral boundaries and expand the evidence base of what works and how to take it to scale.
The reality is that financial resources are rarely truly fungible across sectors, so it is much more of a question of how to best shape investments in sectors that can provide direct and indirect interventions. It is essential to design interventions properly, whether direct or indirect, health or non-health. That means targeting them to the specific geographies, age groups, or socio-economic groups that are most at risk. And it means delivering services with high enough coverage and fidelity to have the desired impact.